Clinical characteristics analysis of patients with Meniere's disease and vestibular migraine
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摘要: 目的 分析梅尼埃病(MD)与前庭性偏头痛(VM)共病患者的临床特点，提高对该疾病的认识，达到精准治疗。方法 对18例MD与VM共病患者的发病年龄、眩晕及头痛的发作特点、听力及前庭功能检查、运动病史、家族史等进行回顾性分析。结果 18例MD共19耳(双侧MD 1例)，左侧11耳，右侧8耳；二期4耳，三期13耳，四期2耳。发病年龄12~58岁，平均36.5岁，头痛比眩晕平均早发病7.5年。眩晕持续时间为30 min~24 h；头痛主要表现为单侧颞部跳痛，可伴随眩晕发作或独立发作，持续时间为15 min~48 h；所有患者眩晕或头痛发作时曾出现过畏声和(或)畏光；9例患者出现过单次眩晕发作伴有头痛，但无耳部症状；7例有视觉先兆；11例有运动病病史；10例有相关家族史。耳蜗电图异常11耳；c-VEMP异常11例；冷热试验异常13例；速度阶梯试验异常4例。结论 MD与VM均表现为眩晕反复发作，MD有明确的感音神经性聋的证据，同时可出现耳蜗电图、c-VEMP、水平半规管功能的异常改变；VM有明确的偏头痛发作史，可伴随畏光、畏声、视觉先兆等偏头痛特性；当患者同时符合MD与VM诊断标准时，可诊断为共病，需同时进行治疗。Abstract: Objective To analyze the clinical characteristics of patients with Meniere's disease and vestibular migraine, improve the understanding of such diseases for accurate treatment.Method Eighteen patients with MD and VM were reviewed and the clinical characteristics of the patients were evaluated.Result There were 4 males and 14 females whose average age was 55.2 years old. The average onset age was 36.5 years meanwhile the headache occured 7.5 years earlier than the vertigo. The average time of vertigo attacks was 30 min-24 h; The mainly kind of headache was unilateral pulsatile headache with or without vertigo attacks; All patients showed the characteristics of photophobia or phonophobia, 7 of them showed visual aura and 9 of them experienced vertigo attacks with headache but without auditory symptoms; 11 patients experienced motion sickness and 10 patients had a related family history. Electrocochleogram abnormal was 11 ears; c-VEMP abnormal was 11 cases; Caloric test abnormal was 13 cases; Velocity step test abnormal was 4 cases.Conclusion MD and VM shows recurrent vertigo, There are evidences of hearing loss and abnormal changes of electrocochleogram、c-VEMP and lateral semicircular canal function in MD; VM experienced migraine attacks with the characteristics of photophobia、phonophobia and visual aura; The patients can be diagnosed with overlap syndrome when they fulfill the diagnostic criteria of MD and VM at the same time and the two diseases should be treated at the same time.
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Key words:
- Meniere's disease /
- vestibular migraine /
- overlap syndrome
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表 1 MD组与共病组患者的临床特点比较
% 组别 眩晕平均发作频率 冷热试验异常 遗传史 运动病史 MD组 1次/8周 75.0 15.0 20.0 共病组 1次/2周 72.2 55.6 61.1 χ2/t -4.418 0.231 36.707 34.879 P < 0.01 0.631 < 0.01 < 0.01 
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表 2 VM组与共病组患者的临床特点比较
% 组别 眩晕平均发作频率 冷热试验异常 遗传史 运动病史 VM组 1次/1.5周 10.0 65.0 60.0 共病组 1次/2周 72.2 55.6 61.1 χ2/t 1.847 79.454 1.695 0.021 P 0.073 < 0.01 0.193 0.885
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